January 11, 2018LITTLETON—With its contract running out, town hall is laying groundwork for a temporary ambulance service run by its fire department.
Littleton's contract with CALEX is expected to end in early February, unless the town agrees to a $116,000 annual rate hike. The Saint Johnsbury-based EMS company gave notice in October that it would be ending its relationship with the town early, and subsequent negotiations have not managed to find a middle ground.
Town Manager Andrew Dorsett has been unwilling to swallow a doubling of the town's EMS costs, and is already in talks to acquire an ambulance to bridge the gap until a new contract or policy is chosen. That will give Littleton the flexibility it needs:
"It allows the commission to make a fully informed decision without having bought something," Dorsett points out, adding "It keeps our options open, and it keeps the citizens protected."
Under the plan, the fire department would cover Littleton's medical calls for a few months, and the new EMS advisory commission is expected to produce a final recommendation before spring. The commission was officially formed last week, and includes representatives of town departments, seniors, doctors, Sugar Hill, and Easton.
Dorsett is confident the dire department can cover all Littleton's EMS needs until a final recommendation is made:
"These guys are paramedic and AETM trained," he points out.
Fire department members have expressed a similar enthusiasm in the past.
The Littleton Fire Department already responds to all EMS calls, according to Captain Chad Miller. Littleton produces an average of one or two emergency medical calls per day.
Short-term plans involve the purchase of a $50,000 used ambulance. Over a few months, that's comparable to the $20,000 monthly fee to contract a short-term private service.
CALEX's latest offer includes roughly $30,000 annual jumps in price, and would take Littleton's EMS costs from their current level of $118,000 to $295,000 in three years. If signed, the new contract would start in March at an initial annual rate of $236,000. The steepness of future increases has been a key force pushing Littleton to seek a better deal.
Calex CEO Michael Write explains that the lower-priced, initial three year contract was made with bad estimates: outgoing Ross EMS did not provide him with the data he needed to determine a sustainable cost of readiness. In essence, he argues that Calex has been treading water in its New Hampshire market for the past three years, and needs a raise. He also says that the same economics apply to any other company, and while a competitor might underbid to get the contract, they will eventually have to come and ask for more money.
Last year, Calex responded to 1100 calls in New Hampshire and 2700 in Vermont. According to Wright's numbers, New Hampshire calls produced transports at a slightly lower rate: about 43 percent instead of the roughly 47 percent in Vermont. EMS services make most of their revenue from transporting patients to or between hospitals—simply responding to calls nets them little. In addition, he explains that New Hampshire is a more challenging environment to secure payment in.
Littleton is covered by one of Calex's six ambulance teams, and the company employs about 45 people in New Hampshire and Vermont.
Dorsett is also laying long-term plans for Littleton's own permanent fire-based EMS service, if the selectmen and voters decide to go that route.
Several budget line items and warrant articles have been prepared which would allow voters to implement municipal EMS at town meeting. In the event that negotiations drag on into March, Littleton would be fully prepared to call up the fire department to full time service.
If it took on municipal EMS, Littleton expects to make back some $345,000 annually, which includes fees currently paid to CALEX and billings from insurance companies for medical transports.
A new ambulance would be paid for over five years, at about two percent interest, with a total cost of some $200,000 to $300,000. A quick repayment plan makes room for increasing maintenance costs in the second half of the vehicle's life, and generally provides slightly better rates.
Littleton currently houses CALEX's ambulances and medical teams, and so has ample space for vehicles, equipment, and personnel.
Dorsett is clear that his contingency is about filling a gap, not imposing a new policy: "This contingency that we're doing is to meet the immediate demand, and to continue the high quality of safety that Littleton expects, without risk to safety."
Of course, Littleton could have sought a short-term contract from one of its potential new contractors to fill the gap. That would cost the town about $20,000 per month. Besides the likely savings from doing it themselves, Dorsett says the fire department's familiarity with the area is a key asset.
In emergency conditions, minutes can mean the difference between life and death. If needs be, the Littleton fire team will take on that challenge for as long as Littleton needs.